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M <br />Dale mn 8/31/2011 3:45:02PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repon #5021 <br />Run by Pages <br />Facility Information as of 8131/2011 <br />Criteria: <br />INFORMATION <br />Owner ID OW0016703 <br />Owner Name PETER NASH <br />Owner DBA EASY FUEL <br />Owner Address 1346 E TAYLOR ST <br />SAN JOSE, CA 95133 <br />Home Phone Not Specified <br />WorkBusiness Phone 408-280-5235 <br />Mailing Address 1346 E TAYLOR ST <br />SAN JOSE, CA 95133 <br />Care of <br />FACILITY FILE INFORMATION <br />Make changeslcorrections In RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />Naw Owner ID : <br />Facility ID FA0020345 <br />Facility Name EASY FUEL <br />Location 2420 E EIGHT MILE RD <br />STOCKTON, CA 95210 <br />Phone 408-280-5235 xO <br />Mailing Address 1346 E TAYLOR ST <br />SAN JOSE, CA 95133 <br />Care of <br />Location Code <br />All Phone <br />808 District <br />Fax <br />APN <br />EMail . <br />EMERGENCY NOTIFICATION ONTTACT OR ATION <br />Contact Nameaf�T <br />Title �1(Lal•tgL�rA,$/I0 <br />Day Phone HPI IM s'a, <br />Night Phone 11tq?, 'e pN6, a 191. <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0036332 <br />New ACcoun[ID:: <br />__.... __......... _ _—Mail Innoicesto— <br />_.._.----- __..biaiHnvoicestar---Ovmer/—Facility-/—Account — <br />Account Name PETER NAS <br />(C'mJe cad) <br />Account Balance as of 8131/2011: $0.00 <br />(Cad. a e> <br />Transfer to Acdyelnaclve <br />Proprom,£kmeM ar,d Descdpdsn Record 10 <br />Employee ID aro Nem. Status Nen Gemara Delete <br />2244 -PACT TRANSFER RECORD -DES PRO535230 <br />Active Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHPRO535263 <br />Active Y N A I D <br />BI W NG and COMPLIANCE ACKNO EMEND 1, me u hers®ned ovmer, operatca or agent o/ same, acklwa./edge that all ata, ar or project Vocalic. PH&EHD howdy chargee associated Wm Ws <br />ctivity sal ba,o.1. <br />facility or ab9kd tp the pa 4e t <br />e OWN en ma fond. I also carGry mat all operations Wit be penamnd in accordance with all applicabb Ordnare Codes anNer Standards and <br />Stara wWor Federal Lava. <br />APPLICANTS SIGNATURE: <br />Date <br />Program Records to he TRANSFERED: <br />Water System to be TRANSFERED: _ <br />Payment Type Che <br />REHS: <br />COMMENTS: <br />l\eh-envlenvision\reports\5021.rpt <br />Number <br />$25.00 = <br />Date <br />Amount Paid Date _I_I_ <br />_ Amount Paid Date / I <br />Receiv <br />_ Account out:' <br />ut Date ! //I, <br />